Skeletal Muscle Evaluation in Patients With Acromegaly

Abstract

Context: Patients with acromegaly are characterized by chronic exposure to high growth hormone (GH) and insulin-like growth factor-1 levels, known for their anabolic effect on skeletal muscle. Therefore, an increased skeletal muscle mass could be hypothesized in these individuals. Herein, we have performed a systematic revision of published evidence regarding skeletal muscle mass, quality, and performance in patients with acromegaly.

Evidence acquisition: A systematic review of the literature in the PubMed database up to September 1, 2023, was conducted with the following query: acromegaly AND ("muscle mass" OR "skeletal muscle"). We excluded studies that did not compare different disease states or used nonradiological methods for the skeletal muscle analyses, except for bioelectrical impedance analysis.

Evidence synthesis: Fifteen studies met the inclusion criteria. A total of 360 patients were evaluated for skeletal muscle mass, 122 for muscle fatty atrophy, and 192 for muscle performance. No clear evidence of increased skeletal muscle mass in patients with active disease compared to control or healthy individuals emerged. As for skeletal muscle quality, we observed a trend toward higher fatty infiltration among patients with acromegaly compared to healthy participants. Likewise, patients with active disease showed consistently worse physical performance compared to control or healthy individuals.

Conclusion: Skeletal muscle in acromegaly has lower quality and performance compared to that of healthy individuals. The small number of published studies and multiple confounding factors (eg, use of different radiological techniques) contributed to mixed results, especially regarding skeletal muscle mass. Well-designed prospective studies are needed to investigate skeletal muscle mass in patients with acromegaly.

Keywords: acromegaly; function; mass; myopathy; quality; skeletal muscle.

Figure 1.

PRISMA flowchart. ^aNot written in English. ^bExcluded by title. ^cOnly studies comparing different disease statuses (ie, active acromegaly vs controlled acromegaly) or a specific disease status vs control group (ie, active acromegaly vs control group or controlled acromegaly vs control group) have been included. ^dBioelectrical impedance analysis has been included.

Figure 2.

Techniques employed to assess A, skeletal muscle mass, and B, fatty atrophy. A technique was counted as one each time it was performed on a patient with acromegaly. If the same technique was used on the same patient with acromegaly at a different time and with a different disease status, it has been counted as two. BIA, bioelectrical impedance analysis; DXA, dual-energy x-ray absorptiometry; HMRS, proton magnetic resonance spectroscopy; MRI, magnetic resonance imaging; US: ultrasound.

Figure 3.

Analyses performed on A, skeletal muscle mass; B, fatty atrophy; and C, performance. Each thick line on the y-axis represents 1 analysis defined as a comparison of 2 different groups with a given technique. Some studies performed more than 1 analysis because they compared 2 groups with more than 1 technique or compared more than 2 groups with each other. AD, active disease group; CD, controlled disease group; CTR, control group.